Important North Carolina Workers' Compensation Forms

Hemmings & Stevens, PLLC Law Firm of Raleigh, NC

When making a Workers' Compensation claim, the forms are extremely important, as well as the deadlines for filing the forms. Some of the most important forms you may need to be familiar with are:

Form 19: This is the Report of Your Injury form to be completed by your employer.

Form 18: This is the Injured Worker Claim form and must be completed and filed with the Industrial Commission when you have been injured on the job.

Form 18B: This is a claim form for several occupational diseases, including lung disease asbestosis, silicosis and byssinosis.

Form 33:This is the Request that Claim Be Assigned for Hearing. This form can be filed to request a hearing if you have a dispute with your employer concerning your medical care or other issues. This form can also be filed if you are not receiving all, or some, of the benefits to which you are entitled.

Form 25P: This is a form to List Itemized Statement for Charges or Drugs. The employee can use this form to obtain reimbursements for prescriptions.

Form 25T: This is a form to List an Itemized Statement of Charges for Travel. Employees are entitled to reimbursement for mileage if the employee travels 20 miles or more round trip for medical treatment.

Form 24: This is an Application to Terminate or Suspend Payment of Compensation. An employer may file this form if it is paying Workers' Compensation benefits and seeks to terminate these benefits. If an employee is receiving compensation and disagrees that benefits should be stopped, it is very important for an employee to timely respond to the Form 24 request.

The forms may be downloaded and printed by clicking the form name links above. Thay may also can be found on the North Carolina Industrial Commission website. The Comission's website has electronic forms for instant submission as well.

If you have questions or concerns about a Workers' Compensation claim, please contact the North Carolina Workers' Compensation lawyers at Hemmings & Stevens PLLC today. We offer free initial consultations and work on a contingent fee basis, which means there are no fees unless we make a recovery for you. For assistance, call us at (919) 277.0161.

This article regarding Workers' Compensation is for informational purposes only and is not legal or medical advice. You may need to seek the advice of a Workers' Compensation lawyer at the law firm of Hemmings & Stevens, PLLC, that has experience in these matters, to help you, if you have a Workers' Compensation claim.

 

 

 

 

Hemmings & Stevens PLLC
Attorneys At Law
(919) 277.0161
5613 Duraleigh Road Suite 151 • Raleigh, North Carolina 27612